Optical requirements on magnification systems for intracranial video microsurgery

Ebner, Florian; Marquardt, Jakob S.; Hirt, Bernhard; Tatagiba, Marcos; Duffner, Frank

doi:10.1002/micr.20915

Cited by 5 publications

(2 citation statements)

References 17 publications

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“…The significant difference between microscopic surgical manipulation and manipulation with RoboticScope is the relationship between the visual line and surgical site: in microscopic manipulation, the visual line is directed towards the surgical site [9][10][11]. When using the RoboticScope, the visual line does not necessarily point towards the surgical site, which is, at first, an unusual situation for the surgeon.…”

Section: Discussionmentioning

confidence: 99%

Performance of microvascular anastomosis with a new robotic visualization system: proof of concept

Böhm¹,

Schuler²,

Riepl³

et al. 2021

J Robotic Surg

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Microvascular procedures require visual magnification of the surgical field, e.g. by a microscope. This can be accompanied by an unergonomic posture with musculoskeletal pain or long-term degenerative changes as the eye is bound to the ocular throughout the whole procedure. The presented study describes the advantages and drawbacks of a 3D exoscope camera system. The RoboticScope®-system (BHS Technologies®, Innsbruck, Austria) features a high-resolution 3D-camera that is placed over the surgical field and a head-mounted-display (HMD) that the camera pictures are transferred to. A motion sensor in the HMD allows for hands-free change of the exoscope position via head movements. For general evaluation of the system functions coronary artery anastomoses of ex-vivo pig hearts were performed. Second, the system was evaluated for anastomosis of a radial-forearm-free-flap in a clinical setting/in vivo. The system positioning was possible entirely hands-free using head movements. Camera control was intuitive; visualization of the operation site was adequate and independent from head or body position. Besides technical instructions of the providing company, there was no special surgical training of the surgeons or involved staff upfront performing the procedures necessary. An ergonomic assessment questionnaire showed a favorable ergonomic position in comparison to surgery with a microscope. The outcome of the operated patient was good. There were no intra- or postoperative complications. The exoscope facilitates a change of head and body position without losing focus of the operation site and an ergonomic working position. Repeated applications have to clarify if the system benefits in clinical routine.

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Section: Discussionmentioning

confidence: 99%

Performance of microvascular anastomosis with a new robotic visualization system: proof of concept

Böhm¹,

Schuler²,

Riepl³

et al. 2021

J Robotic Surg

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show abstract

“…The motivation of duplicating one IDC is strongly linked to the expected temporal shift. The field of view in cerebrovascular surgery is ∼3 × 3 cm 2 , the mean flow velocity is about ∼10 − 50 cm s and a typical exposed length of a vessel is 1-2 cm (Cieslicki and Ciesla, 2005;Ebner et al, 2011;MacDonald and Frayne, 2015;Zarrinkoob et al, 2015). The expected morphological changes of the IDCs is negligible; in the Supplementary Material (section 3.6), the magnitude of change is shown.…”

Section: Idc Generationmentioning

confidence: 99%

Transit Time Measurement in Indicator Dilution Curves: Overcoming the Missing Ground Truth and Quantifying the Error

2021

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The vascular function of a vessel can be qualitatively and intraoperatively checked by recording the blood dynamics inside the vessel via fluorescence angiography (FA). Although FA is the state of the art in proving the existence of blood flow during interventions such as bypass surgery, it still lacks a quantitative blood flow measurement that could decrease the recurrence rate and postsurgical mortality. Previous approaches show that the measured flow has a significant deviation compared to the gold standard reference (ultrasonic flow meter). In order to systematically address the possible sources of error, we investigated the error in transit time measurement of an indicator. Obtaining in vivo indicator dilution curves with a known ground truth is complex and often not possible. Further, the error in transit time measurement should be quantified and reduced. To tackle both issues, we first computed many diverse indicator dilution curves using an in silico simulation of the indicator's flow. Second, we post-processed these curves to mimic measured signals. Finally, we fitted mathematical models (parabola, gamma variate, local density random walk, and mono-exponential model) to re-continualize the obtained discrete indicator dilution curves and calculate the time delay of two analytical functions. This re-continualization showed an increase in the temporal accuracy up to a sub-sample accuracy. Thereby, the Local Density Random Walk (LDRW) model performed best using the cross-correlation of the first derivative of both indicator curves with a cutting of the data at 40% of the peak intensity. The error in frames depends on the noise level and is for a signal-to-noise ratio (SNR) of 20 dB and a sampling rate of fs = 60 Hz at fs-1·0.25(±0.18), so this error is smaller than the distance between two consecutive samples. The accurate determination of the transit time and the quantification of the error allow the calculation of the error propagation onto the flow measurement. Both can assist surgeons as an intraoperative quality check and thereby reduce the recurrence rate and post-surgical mortality.

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Neurosurgery: Past, Present, and Future

Tatagiba¹,

Ugarte

Acioly

2014

Handbook of Neuroethics

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Optical requirements on magnification systems for intracranial video microsurgery

Abstract: From an optical point of view current operating microscopes meet the requirements of intracranial microneurosurgery. However, ergonomically further developments are highly desirable. Video microsurgery is a promising field and could hold a solution to this problem.

Cited by 5 publications

References 17 publications

Performance of microvascular anastomosis with a new robotic visualization system: proof of concept

Performance of microvascular anastomosis with a new robotic visualization system: proof of concept

Transit Time Measurement in Indicator Dilution Curves: Overcoming the Missing Ground Truth and Quantifying the Error

Neurosurgery: Past, Present, and Future

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